It Doesn’t Have to Happen: Lessons From a Cholera Epidemic

Lisa SchechtmanLisa Schechtman is the head of policy and advocacy at WaterAid in America, the U.S. member of WaterAid International, the world’s largest NGO focused on providing safe drinking water, sanitation and hygiene education (WASH) services for poor communities in 27 countries around the world. Prior to joining WaterAid, Lisa served as policy director at the Global AIDS Alliance, and was a member of the Developed Country NGO Delegation to the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Lisa has a Masters of Arts in International Human Rights and Global Health Affairs from the University of Denver, and a B.A. in English Literature and French Language from Northwestern University. She is based in Washington, DC.

Charles Dickens wrote “I hope I have taken every available opportunity of showing the want of sanitary improvements in the neglected dwellings of the poor.”

He couldn’t have been more spot on in his observations of the links between sanitation, poverty, rapid urbanization and population growth in the 19th century.
Science has since backed him up: the provision of clean water and sanitation were two of the most important factors in reduced mortality and improved public health in the United States, United Kingdom and other industrializing nations around the turn of the 20th century. For most Americans, cholera, typhoid and other water-borne illnesses are relics of history.

Yet, in the past month, at least 13,000 people have been infected with cholera, and more than 250 have died, in Sierra Leone, Niger and Guinea. And it could have been prevented.

As in Haiti after the disastrous 2010 earthquake, the cholera epidemic raging in these small West African countries is in part due to a tough go with Mother Nature, which has a tendency to destroy infrastructure when she is particularly fierce. Instead of an earthquake, the problem in West Africa this year is a bad rainy season and floods. Earthquake or flood, people are especially vulnerable to nature where their basic needs aren’t met in the first place. Nature brings existing crises into stark relief.

In Haiti, only 17% of the population has access to an improved source of sanitation, defined as a pit latrine or better. In Guinea, Niger and Sierra Leone, 18%, 9%, and 13% respectively, have this relative luxury. A full two-thirds of the populations of these countries lacks the most rudimentary of services—one critical for health, dignity, and even economic growth. (It’s not only these countries with such low coverage rates, mind you, but that’s another blog.)

Cholera is transmitted through contact with contaminated feces, though water or food. Without latrines and waste management, contaminated (and uncontaminated) feces aren’t contained. This increases people’s risk of exposure to a disease that can kill in a matter of hours.

Lack of sanitation can contaminate water sources in the best of circumstances. But in the rainy season, an overabundance of water leads to run-off, which can contaminate water sources thought to be protected, such as wells—wells that entire communities expect to be safe, clean and potable. In other words, cholera can be anywhere.

People living in slums have been hardest hit by this epidemic. Slum dwellers have somewhat different challenges than those in rural areas. While they are geographically closer to a concentration of services, they often live in unrecognized settlements, and their governments may view them as having no legal right to be there and therefore no legal right to services like water and sanitation. Conditions are crowded, making contamination of water sources and human exposure to fecal matter containing cholera more likely.

These are complicated challenges, made more so by a lack of political will—and the lack of planning, budgeting, and donor assistance that goes along with it—to solve the sanitation crisis. National governments have allowed the majority of their populations to live without even a basic pit latrine, and donor governments have prioritized other issues. So the people of West Africa are suffering a cholera epidemic today.

But there is potential for good news out of all this needless suffering and death.

Crises like this epidemic can get us talking about what could have been done to prevent it. They activate new partnerships, bringing together experts who, in the urgency of a crisis, may never otherwise work together, and sometimes lay the groundwork for sustainable change. But first, lives must be saved.

In Sierra Leone and Niger, WaterAid has joined with UN agencies and other NGOs to undertake emergency response in the hardest-hit areas. We are doing home-to-home checks to be sure sanitation facilities are in good working order, providing chlorine tablets and installing biosand filters to ensure that water is safe to drink right now, and doing radio spots to raise awareness of how cholera is spread and what can be done about it.

Crises also highlight mistakes that have been made in the past so we can attempt to fix them moving forward. In response, WaterAid is advocating to the national government in Sierra Leone for a plan that will prevent another cholera epidemic down the road. After all, we know that if there is no money set aside and no plan of action in place, it will be impossible to make headway even under the best of circumstances, let alone a situation as dire as what we face today.

This time, let’s not wait for the Dickens of our generation to remind us of a simple lesson in public health learned a century ago. Let’s keep people alive today. But tomorrow, let’s get down to solving the sanitation crisis, once and for all.